MEDICARE: MS. KIMBERLY ANN FORNEY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164W00000X	Licensed Practical Nurse	166367	NE

General Provider Information

NPI Number	:	1972898443
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KIMBERLY ANN FORNEY

Provider Business Mailing Address
First Line	:	3362 53RD AVE
Second Line	:
City	:	COLUMBUS
State	:	NE
Zip	:	68601-1512
Country	:	US
Telephone Number	:	402-562-1124
Fax Number	:	402-563-0710

Provider Business Practice Location Address
First Line	:	3362 53RD AVE
Second Line	:
City	:	COLUMBUS
State	:	NE
Zip	:	68601-1512
Country	:	US
Telephone Number	:	402-562-1124
Fax Number	:	402-563-0710

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/13/2011
Last Update Date	:	06/13/2011

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